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Gulf Coast Medical Management
To verify your benefits, please call Meritain Customer Service directly at 800.925.2272.
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Behavioral Health Authorization Request
*Member ID:
(As shown on the ID card i.e. 764001234501) 
*Date of Birth:
(mm/dd/yyyy) 		 / /
You may retrieve an existing request by entering your case number.
Case Number:  
For additional information and assistance,
please contact Gulf Coast Medical Management at (941) 917-4326.
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